Korean Journal of Anesthesiology最新文献

Background: Current regional anesthesia techniques used to anesthetize the intercostobrachial nerve (ICBN) for upper arm surgery either lack reliability or have increased procedural risks. Safer and more reliable regional anesthetic techniques are required to block the ICBN effectively. Here, we introduce a novel "axillary serratus anterior plane (A-SAP) block" for anesthetizing the ICBN to allow surgical anesthesia for upper arm arteriovenous fistula (UA-AVF) creation.

Case: We present three cases involving a 79-year-old Chinese male, a 73-year-old Malay female, and a 38-year-old Chinese male, in which the A-SAP block was utilized in UA-AVF creation surgeries. In all three cases, the A-SAP block was performed in combination with a supraclavicular brachial plexus block. None of the patients required local anesthetic supplementation intraoperatively.

Conclusions: The A-SAP block reliably and safely anesthetized the ICBN for UA-AVF creation surgery and is a reliable alternative to higher-risk block techniques, such as paravertebral block or neuraxial block.

Background: Removal of intratracheal tumors is challenging due to the difficulty in securing a patent airway before surgery. We report a case of successful removal using jet ventilation with an injection-time-controllable manual jet ventilator.

Case: A 3.3 cm long intratracheal mass was located 5 cm below the vocal cords and obstructing 70-80% of the trachea. Following induction, a rigid telescope under suspension laryngoscopy was used to guide the careful insertion of a hard and long catheter (inner diameter: 1.8 mm; outer diameter: 3 mm; length: 50 cm) beyond the tumor, enabling jet ventilation. The soft, lobulated mass was gradually excised using long forceps under endoscopic visualization. Anesthesia was maintained using total intravenous anesthesia. The operation lasted for 1 h and 45 min.

Conclusions: This device ensured oxygenation and ventilation during the endoscopic removal of a large intratracheal tumor. This approach highlights its utility in managing challenging airway obstructions.

Background: Robot-assisted transaxillary thyroidectomy (RATT) involves extensive flap dissection, leading to significant postoperative pain. This study evaluated the efficacy of pectoral nerve II (PECS II) block in pain relief, opioid reduction, and recovery enhancement.

Methods: This prospective, randomized controlled trial included 83 patients undergoing elective RATT for thyroid conditions. Patients were assigned to the block group (n = 42) or non-block group (n = 41). Pain was assessed using the visual analog scale (VAS) at 1, 4, 24, and 48 hours postoperatively. Secondary outcomes included opioid consumption and Quality of Recovery-15 (QoR-15K) scores at discharge.

Results: The PECS II block group had significantly lower VAS scores at 1 h (3.6 ± 2.5 vs. 6.3 ± 2.3, P < 0.001), 4 h (2.6 ± 2.1 vs. 4.3 ± 2.5, P = 0.002), and 24 h (2.0 ± 1.6 vs. 3.2 ± 2.0, P = 0.002). Opioid consumption was significantly lower in the block group (median: 1 [0.75, 3] vs. 3 [2, 3.5], P = 0.001). QoR-15K pain subdimension scores were higher in the block group (14.5 [12, 17] vs. 10 [8, 14], P < 0.001), while other recovery aspects were comparable.

Conclusions: The PECS II block significantly reduces pain and opioid use in RATT patients, enhancing recovery quality. This opioid-sparing approach supports multimodal pain management, ensuring safer and more comfortable postoperative recovery.

Background: The ideal intravenous (IV) maintenance and resuscitation fluid for patients undergoing orthotopic liver transplantation (OLT) remains unknown. We aimed to determine whether bicarbonate-buffered solution was non-inferior to Plasma-Lyte™ in preventing metabolic acidosis during OLT.

Methods: We conducted a pilot single-center, open-label, randomized trial to compare the physiological effects of intravascular volume maintenance with a bicarbonate-buffered solution vs. Plasma-Lyte™ in adults undergoing OLT. Non-inferiority was defined as a median difference in the standard base excess (SBE) of less than -2.5 mEq/L. The primary endpoint was the standard base excess (SBE) at 5 minutes post-reperfusion. Quantile regression analysis was applied to confirm non-inferiority. Secondary endpoints included other forms of acid-base and electrolyte imbalances at pre-specified time points and postoperative complications.

Results: We randomized 52 adults undergoing OLT. The median (interquartile range [IQR]) volume infused was 5000 (3125, 7000) ml in the bicarbonate-buffered solution group and 5500 (4000, 10,500) ml in the Plasma-Lyte™ group (P = 0.37). The median (IQR) SBE at 5 minutes post-reperfusion was -4.857 (-6.231, -3.565) mEq/L in patients receiving bicarbonate-buffered solution and -4.749 (-7.574, -2.963) mEq/L amongst those in the Plasma-Lyte™ group. The estimated median difference by quantile regression was -0.043 mEq/L (95% CI -1.988 to 1.902 mEq/L; (one-sided P = 0.015). There were no significant differences in the acid-base secondary outcomes, number of complications, or patient mortality. There were no reported adverse events or safety concerns associated with the use of either solution.

Conclusions: A bicarbonate-buffered solution was non-inferior to Plasma-Lyte™ for maintaining acid-base homeostasis post-reperfusion in OLT patients.

Heterogeneity is a critical but unavoidable aspect of meta-analyses that reflects differences in study outcomes beyond what is expected by chance. These variations arise from differences in the study populations, interventions, methodologies, and measurement tools and can influence key meta-analytical outputs, including pooled effect sizes, confidence intervals, and overall conclusions. Systematic reviews and meta-analyses combine evidence from diverse studies; thus, a clear understanding of heterogeneity is necessary for reliable and meaningful interpretations of the results. This review examines the concepts, sources, measurement techniques, and implications of this heterogeneity. Statistical tools (e.g. Cochran's Q, I², and τ²) quantify heterogeneity, whereas τ and prediction intervals, as they use the same units, aid in the intuitive understanding of heterogeneity. The choice between fixed- and random-effects models can also significantly affect the handling and interpretation of heterogeneity in meta-analyses. Effective management strategies include subgroup analyses, sensitivity analyses, and meta-regressions, which identify sources of variability and strengthen the robustness of the findings. Although heterogeneity complicates the synthesis of a single effect size, it offers valuable insights into patterns and differences among studies. Recognizing and understanding heterogeneity is vital for accurately synthesizing the evidence, which can indicate whether an intervention has consistent effects, benefits, or harms. Rather than viewing heterogeneity as inherently good or bad, researchers and clinicians should consider it a key component of systematic reviews and meta-analyses, allowing for a deeper understanding and more nuanced application of pooled findings. Addressing heterogeneity ultimately enhances the reliability, applicability, and overall impact of the conclusions of meta-analyses.

Background: A simple superoposterior approach to thoracic transforaminal epidural injections (TFEIs) under ultrasonographic guidance was proposed to reduce zoster-associated pain (ZAP) involving multiple thoracic nerves and the likelihood of transitioning to postherpetic neuralgia (PHN).

Methods: Patients were prospectively enrolled. Primary endpoints were the burden of illness (BOI) scores and epidural contrast spread. Secondary endpoints included number of needle insertion attempts, sensory blockade, hemodynamic changes, procedure time, radiation dose, adverse events, rescue analgesics, PHN incidence and EuroQoL 5-Dimension scores.

Results: Thirty-five injections were performed in 27 patients. Median levels of cephalad-caudad epidural contrast spread were 3, 4, and 5 ml following injections of 2, 3, and 4 ml. Dorsal epidural spread was observed at levels 3, 4, and 5, whereas concurrent ventral spread was observed at levels 2, 3, and 4. BOI scores at 30-180 d significantly decreased (mean difference [95% CI]: -25.3 [-57.4, 6.6]; P = 0.005), accounting for reduced rescue analgesic requirements and PHN occurrence and improved EuroQoL 5-Dimension scores. Median sensory blockade at 5 min post-procedure was at level 2, 3, and 4 after 2, 3, and 4 ml of therapeutic injectate. No significant hemodynamic changes were noted at 15 min post-injection. No serious adverse events were observed.

Conclusions: Spread of thoracic epidural contrast to all involved nerves was confirmed using this novel technique. Simplified needle placement reduced the technical difficulty and risk of complications. It might be a promising alternative approach for ZAP.

Background: Acute exacerbation of interstitial pneumonia (AE-IP) is associated with high mortality rates. Although the risk factors for AE-IP have been extensively studied, given the small sample sizes, only a few risk factors have been established. This study aimed to investigate the postoperative mortality and factors associated with AE-IP.

Methods: This retrospective study included 482 patients with a preoperative diagnosis of IP who underwent noncardiac surgery between December 2012 and April 2020. AE-IP was diagnosed by a radiologist using computed tomography when worsening respiratory symptoms were observed within 1 month postoperatively. The Cox proportional hazards model was used to compare mortality rates. Candidate factors associated with AE-IP were identified through logistic regression analysis using the variable selection method, followed by case-control analysis using propensity score matching to determine possible factors associated with AE-IP.

Results: The multivariable-adjusted hazard ratios for all-cause and IP-related deaths were significantly higher in patients with AE-IP than in those without AE-IP. Multivariable analysis with variable selection suggested that male sex, higher C-reactive protein (CRP) levels, fraction of inspired oxygen (FiO2) ≥ 60%, and non-lung surgery were candidate factors associated with AE-IP. Case-control analysis using propensity score matching demonstrated that patients with AE-IP had higher CRP levels (P = 0.044) and frequency of FiO2 ≥ 60% (P = 0.035) than those without AE-IP. Furthermore, a positive, nearly linear relationship was observed between FiO2 ≥ 60% duration and AE-IP incidence.

Conclusions: Intraoperative management with FiO2 ≥ 60% and high preoperative CRP levels were significantly associated with postoperative AE-IP.